MEDICARE: SARAH ELIZABETH CROSS LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	18010	MN

General Provider Information

NPI Number	:	1659506525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ELIZABETH CROSS LICSW

Provider Business Mailing Address
First Line	:	1711 COUNTY ROAD B W 320N
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-4075
Country	:	US
Telephone Number	:	651-528-8587
Fax Number	:	651-528-8541

Provider Business Practice Location Address
First Line	:	2708 119TH AVE NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55433-2912
Country	:	US
Telephone Number	:	763-755-3801
Fax Number	:	763-755-1077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2009
Last Update Date	:	11/09/2015

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